İmplante Edilebilen Kardiyoverter Defibrilatör (ICD) Yerleştirilmiş Hastada Kardiyak Rehabilitasyon
Özet
İmplante edilebilen kardiyoverter defibrilatör (ICD), yaşamı tehdit eden ventriküler aritmileri algılayıp tedavi ederek ani kardiyak ölüm riskini azaltan temel bir cihazdır. ICD implantasyon sayılarının giderek artması, bu hastaların kardiyak rehabilitasyon (KR) programlarına daha sık yönlendirilmesini gerektirmektedir. Ancak uygunsuz şoklara ilişkin kaygılar, fiziksel aktiviteye katılımı ve KR’ye uyumu olumsuz etkileyebilmektedir. Güncel kanıtlar, egzersiz temelli KR’nin ICD’li hastalarda güvenli olduğunu, uygunsuz şok riskini artırmadığını ve hatta kardiyorespiratuvar uygunluğu iyileştirerek aritmi insidansını azaltabileceğini göstermektedir. KR’ye alınacak hastalarda klinik öykü, cihaz programlama özellikleri ve psikososyal durum birlikte değerlendirilmelidir. Egzersiz reçetesi, cihazın şok tetikleyici hız limitleri dikkate alınarak, aerobik (sürekli ya da interval) ve dirençli egzersizleri içerecek şekilde bireyselleştirilmelidir. Egzersiz testi, özellikle cihaz ayarlarının güvenli sınırlarının belirlenmesi açısından önemlidir. Rehabilitasyon sürecinde elektroterapi uygulamalarına yönelik elektromanyetik etkileşim riskleri göz önünde bulundurulmalı ve uygun alternatif yaklaşımlar tercih edilmelidir. Ayrıca, ICD ile yaşamın getirdiği şok korkusu, kaygı ve kaçınma davranışlarının yönetilmesi için psikososyal destek KR’nin ayrılmaz bir bileşeni olmalıdır. Tüm bu unsurlar bir araya geldiğinde KR, ICD’li hastalarda hem fiziksel kapasiteyi hem de yaşam kalitesini anlamlı biçimde artıran bütüncül bir tedavi yaklaşımı sunmaktadır.
Referanslar
Zeppenfeld K, Tfelt-Hansen J, de Riva M, et al. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. European Heart Journal. 2022;43(40):3997-4126. doi:10.1093/eurheartj/ehac262.
Kossaify A. Sensing and detection functions in implantable cardioverter defibrillators: the good, the bad and the ugly. Acta Cardiologica Sinica. 2020;36(4):308-317. doi:10.6515/ACS.202007_36(4).20191201A.
Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Circulation. 2018;138(13):e272-e391. doi:10.1161/CIR.0000000000000549.
Boersma L, Barr C, Knops R, et al. Implant and midterm outcomes of the subcutaneous implantable cardioverter-defibrillator registry: the EFFORTLESS study. Journal of the American College of Cardiology. 2017;70(7):830-841. doi:10.1016/j.jacc.2017.06.040.
Auricchio A, Hudnall JH, Schloss EJ, et al. Inappropriate shocks in single-chamber and subcutaneous implantable cardioverter-defibrillators: a systematic review and meta-analysis. Europace. 2017;19(12):1973-1980. doi:10.1093/europace/euw415.
Olde Nordkamp LRA, Brouwer TF, Barr C, et al. Inappropriate shocks in the subcutaneous ICD: incidence, predictors and management. International Journal of Cardiology. 2015;195:126-133. doi:10.1016/j.ijcard.2015.05.135.
Nielsen KM, Zwisler AD, Taylor RS, et al. Exercise-based cardiac rehabilitation for adult patients with an implantable cardioverter defibrillator. Cochrane Database of Systematic Reviews. 2019;2(2):CD011828. doi:10.1002/14651858.CD011828.pub2.
Pandey A, Parashar A, Moore C, et al. Safety and efficacy of exercise training in patients with an implantable cardioverter-defibrillator: a meta-analysis. JACC: Clinical Electrophysiology. 2017;3(2):117-126. doi:10.1016/j.jacep.2016.06.008.
Steinhaus DA, Lubitz SA, Noseworthy PA, et al. Exercise interventions in patients with implantable cardioverter-defibrillators and cardiac resynchronization therapy: a systematic review and meta-analysis. Journal of Cardiopulmonary Rehabilitation and Prevention. 2019;39(5):308-317. doi:10.1097/HCR.0000000000000389.
Ambrosetti M, Abreu A, Corrà U, et al. Secondary prevention through comprehensive cardiovascular rehabilitation: from knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. European Journal of Preventive Cardiology. 2020;27(16):1816-1836. doi:10.1177/2047487320913379.
Pedretti RFE, Iliou MC, Israel CW, et al. Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary Prevention and Rehabilitation Section) and European Heart Rhythm Association (EHRA). European Journal of Preventive Cardiology. 2021;28(15):1736-1752. doi:10.1093/eurjpc/zwaa121.
Dunbar SB, Dougherty CM, Sears SF, et al. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter-defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012;126(17):2146-2172. doi:10.1161/CIR.0b013e31825d59fd.
Corrà U, Agostoni PG, Anker SD, et al. Role of cardiopulmonary exercise testing in clinical stratification in heart failure. A position paper from the Committee on Exercise Physiology and Training of the Heart Failure Association of the European Society of Cardiology. European Journal of Heart Failure. 2018;20(1):3-15. doi:10.1002/ejhf.979.
Castro Gómez C, Devia Quiñonez MJ, López Gómez D, et al. Cardiac rehabilitation in patients with implantable cardioverter-defibrillator: a scoping review. Pacing and Clinical Electrophysiology. 2025; doi:10.1111/pace.70032.
Iliou MC, Blanchard JC, Lamar-Tanguy A, et al. Cardiac rehabilitation in patients with pacemakers and implantable cardioverter defibrillators. Monaldi Archives for Chest Disease. 2016;86(2):756. doi:10.4081/monaldi.2016.756.
Heidbuchel H, Carré F. Exercise and competitive sports in patients with an implantable cardioverter-defibrillator. European Heart Journal. 2014;35(44):3097-3102. doi:10.1093/eurheartj/ehu130.
Van De Heyning CM, Elbarasi E, Masiero S, et al. Prospective study of tricuspid regurgitation associated with permanent leads after cardiac rhythm device implantation. Canadian Journal of Cardiology. 2019;35(4):389-395. doi:10.1016/j.cjca.2018.11.01.
Dimitrow PP, Rajtar-Salwa R, Tokarek T. Exercise stress test methodology and safety in hypertrophic cardiomyopathy. European Journal of Preventive Cardiology. 2020;27(17):1819-1820. doi:10.1177/2047487319901059.
Cramer GE, Gommans DHF, Dieker H-J, et al. Exercise and myocardial injury in hypertrophic cardiomyopathy. Heart. 2020;106(15):1169-1175. doi:10.1136/heartjnl-2019-315818.
Vanhees L, Kornaat M, Defoor J, et al. Effect of exercise training in patients with an implantable cardioverter defibrillator. European Heart Journal. 2004;25(13):1120-1126. doi:10.1016/j.ehj.2004.04.034.
Berg SK, Pedersen PU, Zwisler AD. Comprehensive cardiac rehabilitation improves outcome for patients with implantable cardioverter defibrillator: findings from the COPE-ICD randomised clinical trial. European Journal of Cardiovascular Nursing. 2015;14(1):34-44. doi:10.1177/1474515114521920.
Fitchet A, Doherty PJ, Bundy C, et al. Comprehensive cardiac rehabilitation programme for implantable cardioverter-defibrillator patients: a randomised controlled trial. Heart. 2003;89(2):155-160. doi:10.1136/heart.89.2.155.
Denniss AR, Zecchi R. Cardiac rehabilitation for patients with an implantable cardioverter defibrillator. Trayanova N (Ed.), Cardiac Defibrillation—Mechanisms, Challenges and Implications içinde. Rijeka: InTechOpen; 2011. p. 213–220. doi:10.5772/20765.
Akdal A, Karavelioglu Y, Gokdeniz T, et al. Combined arm–leg endurance training vs. leg endurance training in patients with an implantable cardioverter defibrillator: a randomized controlled study. Heart & Lung. 2025;70:82-92. doi:10.1016/j.hrtlng.2024.11.011.
Squeo MR, Di Giacinto B, Perrone MA, et al. Efficacy and safety of a combined aerobic, strength and flexibility exercise training program in patients with implantable cardiac devices. Journal of Cardiovascular Development and Disease. 2022;9(6):182. doi:10.3390/jcdd9060182.
Digby GC, Daubney ME, Baggs J, et al. Physiotherapy and cardiac rhythm devices: a review of the current scope of practice. Europace. 2009;11(7):850-859. doi:10.1093/europace/eup102.
Dunbar SB, Dougherty CM, Sears SF, et al. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter-defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012;126(17):2146-2172. doi:10.1161/CIR.0b013e31825d59fd.
Sears SF, Rosman L, Sasaki S, et al. Defibrillator shocks and their effect on objective and subjective patient outcomes: results of the PainFree SST clinical trial. Heart Rhythm. 2018;15(5):734-740. doi:10.1016/j.hrthm.2017.12.026.
